Orthognathic Surgery Prep Interview with PostGradGrin

Post Grad Grin’s graduation picture – before getting braces the second time

Our interview series continues with PostGradGrin who’s a college graduate living in Southern California. She’s currently a month into having braces on in preparation for orthognatic surgery. If you’re considering orthognatic surgery, this is one interview that you cannot miss!

Hi postgradgrin. Thanks for taking the time for this interview. Before we begin, can you tell us a little bit about yourself?

Thank you for having me! I’m a 22-year-old college graduate from southern California. Since graduating from college on the East Coast this past June, I’ve decided to move back West to live and work at home so that I can finally correct my underbite through orthognathic surgery. My upper jaw will be brought forward and my lower jaw will be set back. In the interest of optimum facial balance, once my jaws are in the right place, my surgeon may also perform a genioplasty to re-position my chin.

I got traditional metal braces on August 1st, 2012, and I will be ready for surgery in December 2012 or January 2013. I will probably be done with the whole process – recovered and braces off – by summer 2013.

PostGradGrin’s underbite before braces and surgery

Your case is a little different from most. Can you expand on this process more please?

My parents have always known about my underbite (a childhood dentist probably pointed it out to them), and they were wise enough to take me to the orthodontist for the first time when I was just seven years old. I had “the works” – spacers, palate expander, rubber bands, headgear, braces, retainers – all in the hopes that we might be able to fix the underbite without surgical intervention.

In some cases, this is possible; in others, there is just too much bone growth in one jaw and/or not enough growth in the other. My orthodontist did the best he possibly could, and by age 14 when my braces came off, I had a very presentable and functional bite. This was partially accomplished by flaring my upper teeth out to make my underbite less noticeable. It was not quite the slight overbite that is the Western standard of beauty, but it was close enough.

PostGradGrin’s smile at her orthodontist’s office after getting braces

The orthodontist warned my parents and me that should my jaw continue to grow, I would probably be looking at orthognathic (jaw) surgery in the future. He gave me upper and lower retainers to wear at night, and sent me on my way.

Sure enough, by age 17, my lower jaw had grown forward several millimeters, and I once again had an underbite.

My braces have been installed and will be removed after my surgery when the bone heals. During the surgery, my mouth will be banded shut by the surgeon via surgical hooks that will be attached to my braces.

You’ve been researching this for several years now. What were your thoughts going through this process?

When I first started thinking about jaw surgery at age 17, I didn’t do any research at all. I went to my first oral surgery consultation with my mother, and was completely overwhelmed! I didn’t know I would need to get braces again, let alone that my upper jaw – not just my lower jaw – was the problem! I learned that my underbite was a product of an over-developed mandible (lower jaw) and an under-developed maxilla (upper jaw). Honestly, learning this made me feel like I was somehow deformed!

Learning about the recovery process was what shocked me the most. I would be banded shut for a few weeks, and on a strict liquid diet. I was advised to gain weight before the surgery to offset the weight loss while I was on the liquid diet. I wouldn’t be allowed to brush my teeth for the first week or two. I wouldn’t be allowed to sneeze. I wouldn’t be allowed even light aerobic exercise for at least a month, and no heavy lifting or straining for quite a while after that. I could experience numbness in my face for up to a year after surgery.

I was also really worried about how different I would look after surgery – would people judge me for making changes to my appearance? Would my friends even recognize me?

Over time, those concerns grew less important as I developed some functional issues and my desire to correct my facial imbalance grew. I didn’t feel like the person I saw in my own pictures, with a lopsided smile straight-on, and a heavy lower face that doesn’t match my petite frame. From the side, my prominent lower jaw makes me look angry even when I’m not!

More importantly, I started to realize that my frequent sinus infections (several times each year); ear popping, pressure, and infections (which you’re not supposed to have as an adult! I once had one bad enough to force me to cancel a flight); lifelong short-windedness; and mouth breathing (especially at night) could be related to my jaw issues. Because my jaws don’t line up, neither do my teeth, which will cause them to wear down faster than the average person’s over time. I also can’t bite cleanly through a sandwich – I have to shake my head back and forth to tear the bread!

What finally made you decide to go through with it?

It’s important to be patient with braces and surgery as your bite may get worse before it gets better. PostGradGrin’s openbite after braces illustrates this.

I started to do some real research my junior year of college and found a wealth of information on jaw surgery blogs! It’s amazing how much people are willing to share, and it really made all the difference for me! I realized that there were patients younger than me who were brave enough to undergo this type of surgery, and who had significant, beautiful results, while still looking like themselves. Some patients blogged every day post-op, so I was able to follow their journey the whole way through – all the ups and downs of swelling and not being able to eat solid foods. If they survived it, why couldn’t I?

I’m extremely squeamish about all things medical, so the thought of surgery naturally terrifies me. In order to proceed with jaw surgery, I had to have all of my wisdom teeth removed when I was 20. All four were growing horizontally instead of vertically, and were quite impacted. This served as a sort of “test run” for jaw surgery – I proved to myself that I could be cooperative with the doctors and brave my fear of needles etc. When I woke up from the anesthesia, instead of panicking, I was smiling! I was so proud of myself!

Of course, double jaw surgery is a much more complicated procedure, and it’s not a procedure that fits seamlessly into most lifestyles. Because my family is on the West Coast and I went to college on the East Coast, preparing for and having surgery while I was still in school was out of the question. As much as I wanted to start the life of a normal twenty-something upon graduation and live in a new city or even abroad, I decided that in my case, the best way to move this process along was to move back in with my parents and spend a year getting this surgery out of the way. My family has been extremely supportive – both emotionally and financially – and I couldn’t even consider something like this without their help!

The purpose of braces before surgery is to move the teeth into place. In this picture, PostGradGrin’s molars are touching – the bite will be fixed with surgery and post-surgery braces.

This is your second go around with braces so you’re a little wise and more experiences. What did you wish you knew before?

I’m pretty sure I didn’t floss when I had braces as a kid! I probably should have been a little more diligent about that!

But other than that, I was always a really good patient, even as a kid. I knew I had an underbite and that doing everything my orthodontist told me was extremely important to avoid future problems. I also knew that orthodontics were a luxury that not every child gets, so I felt I owed it to my parents to get the most out of my treatment. I wore my retainers every night from the day my braces were removed at age 14 until the day I got them again at age 22! Every dentist, orthodontist, and surgeon I’ve consulted with has said that that is the reason my teeth look as good as they do, and why I will only need braces for about 4 or 5 months prior to surgery! (Many patients I’ve communicated with need 6-12 months of braces prior to surgery; some as many as 18!)

You’ve had some adventures with spacers, broken brackets and even a canker sore (ouch!) – how did you deal with them?

The first week after getting my braces was the worst – mainly because I got a ton of canker sores on my gums! My orthodontist said this can happen after long appointments with your mouth open the whole time. I used Peroxyl mouthwash to speed up healing, and Orabase paste to numb the affected areas.

In the month since I got my braces put on I’ve had broken brackets, loose bands, wiggly spacers, and popped wires! It’s important to ask questions at each appointment so that you understand what should be going on in your mouth – that way you can tell if something is wrong. Don’t be afraid to pick up the phone and call your orthodontist’s office if something doesn’t feel right – even if it’s the weekend! If there is a serious problem, your orthodontist will make sure it gets taken care of as soon as possible.

Flossing with braces is, to put bluntly, a huge pain. What tricks have you discovered to make it easier?

The key is making flossing a part of your routine. No skipping, no exceptions! The threaders provided by my orthodontist have made it possible – they help you feed floss under the wire and between the teeth. Some patients I know use a Water Pik, which I understand is almost as good as flossing, but I haven’t thought about making that investment yet. For now, being diligent about plain old flossing is getting the job done. I also use a proxabrush (the pipe cleaner-like little brush that I used to think was just for removing pieces of food stuck in your teeth) to brush under my wires.

It helps to be extremely personally invested in your whole process: with all the time and money you’re spending on orthodontics and jaw surgery, flossing every day seems like a minor commitment in comparison. Also, the thought of having a cavity drilled with braces on is pretty horrifying to me!

Breakfast smoothies! Extremely filling, and a great way to cover many of the main food groups first thing in the morning. I haven’t been able to eat green salads since getting my braces on, so breakfast smoothies are one of the most important ways that I get my greens in. If you toss a handful of washed and dried kale into the blender, along with some fruit and yogurt, you can’t even taste the greens! But you’re getting tons of fiber and important vitamins and minerals, like calcium. Many people don’t know that leafy green vegetables have more calcium than dairy products!

How are you going to celebrate when everything is done in 2013?

I’m trying not to get ahead of myself, since surgery is still a few months away and recovery will take several months… But I am really looking forward to biting into an apple again! And biting cleanly through a baguette sandwich without its contents spilling out! I also can’t wait for the day when I can pose for a picture without constantly worrying about the angle of my jaw. I’ll pose for profile shots with confidence!

On a less superficial note, one of the benefits of this surgery is that it is going to widen my airway and open up my sinuses. After so many years of being “the slow kid” and getting short of breath easily (despite always being at a healthy body weight), I can’t wait to realize my full athletic potential once my surgeon says I can start exercising again.

PostGradGrin’s One Month Anniversary with Braces!

Any final tips and tricks for people considering jaw surgery?

Do your research! The internet is an incredible resource, and there are so many stories out there that past and present patients have so graciously shared. Bloggers usually answer questions pretty readily and honestly, so don’t hesitate to post one in the comment section of a blog post. I would be happy to answer any questions on my blog: www.thepostgradgrinjawsurgery.wordpress.com

Consult with at least two surgeons. Go to the best surgeon you can, no matter how far you have to travel (even out of state!) – especially if you have any TMJ issues. A good surgeon should have at least several hundred jaw surgeries under his or her belt! Orthognathic surgery should be the only type of surgery they do. Make sure you feel comfortable with your surgeon, both in terms of reputation and personality; it’s important to be able to communicate effectively so you understand the process and the end result that the surgeon is aiming for. Choose an orthodontist that your surgeon has worked with in the past, and with whom he or she maintains a good relationship. Clear communication between your surgeon and your orthodontist is crucial – it could mean fewer months in braces for you!

Make sure your insurance policy doesn’t have an orthognathic surgery exclusion. Some insurance companies are very generous, but others will flat-out refuse to pay for this type of surgery because it is all too often viewed as elective and cosmetic (even though it isn’t!). Surgeries like this cost anywhere from $30,000 to $70,000; some insurance companies will cover the procedure in full, while others won’t give you a cent.

Finally, keep things in perspective. It’s not a procedure for the faint at heart, but if you focus on the significance of the larger outcome, time will start to fly. A year or two in braces may seem like a long time, but a lifetime of healthy teeth and jaws is far more precious!

If you are considering getting orthodontic work, be sure to check out our comprehensive braces guide and our orthodontist guide. If you’d like to read more interviews with real people who’ve undergone orthodontic treatment, be sure to check out other interviews in our series:

2 Responses to Orthognathic Surgery Prep Interview with PostGradGrin

Do you have any way of contacting postgrad? Her blog was the BEST. The most informative, thorough, inspiring and encouraging jaw surgery blog I have ever come across. I followed it regularly and learned so much from it. Why did she take it down? It was an invaluable patient resource. I have missed reading it so much, especially since I’m now in the process of organizing surgery for my underbite, and she has so much knowledge and experience to share with the world.

There was no other blog quite like thepostgradgrin 🙁
I wish she would consider republishing her blog.

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